Insurance Coverage for Addiction Treatment

insurance

Getting help for drug and alcohol addiction isn’t easy, but it is the first step. Decades of evidence-based research demonstrates that there is a major discrepancy between the number of people who need addiction treatment in America and those who meet that demand and receive it.  

Based on research conducted by the US Department of Justice, about 21 million people (1 in 13 people) ages 12 and older, that needed substance abuse treatment, only 3.8 million (18 percent) were able to obtain it. 

There are numerous reasons which all majorly contribute to the decrease in the demand for treatment, but, the main cause above all else is affordability. 

For millions of people, after admitting they need help, their main concern when entering rehab for drug and alcohol addiction is whether or not they will be able to afford treatment. Some people may not have the insurance to cover the costs or believe live in an area where options for help may not be readily available.  

Addiction treatment is expensive, but for those who suffer from substance use disorders, it is imperative. Most people think they can’t afford help, as they are unaware that there are options out there available. One reason that people may not seek help, is that in the past, treatment services for addiction were not required to be covered under insurance plans. 

However, thanks to the Affordable Care Act, today, insurance companies have to cover the cost addiction and mental health disorders under their plans. 

Everyone’s situations are unique, and therefore, whatever the case may be, today, various changes have made care more accessible for those who need it, thus, reducing the gap of healthcare, and increasing the number of people receiving the treatment. 

How Insurance Works For Drug And Alcohol Rehab Programs

While there are various ways to pay for addiction treatment, insurance is the most effective and smart way to do so. The reason being is that your insurance plan can either reduce expenses or completely cover the cost of treatment depending on what type of plan and coverage it entails.  

In other words, the cost of rehab varies for everyone, as it depends on your needs and the level of care needed. 

For example, those who have more severe levels of addiction, residential treatment programs offer the highest level of care possible, and therefore, is the most expensive option. Outpatient programs may cost less, but, it may not provide someone with a sufficient amount of support they need to recover and maintain sobriety. 

Insurance coverage is the best option for people who need addiction treatment. There are various options and resources available to help those alleviate their financial burdens, and determine the best financial options for their circumstance. 

Therefore, individuals and their loved ones can focus on what matters most, finding the right treatment facility that specializes in treating substance use disorders and mental illness thoroughly and effectively. 

Does Insurance Cover Addiction Rehab?

Yes, insurance does cover addiction rehab, thanks to The Affordable Care Act (ACA). Whether or not your insurance covers rehab, however, does depend on your specific plan purchased and its benefits. There may be limits on the type of treatment program the insurance company is willing to cover and for what length of time. 

The Affordable Care Act (ACA) 

Back in the day, health insurance was considered somewhat of a luxury. In a way, it still is. Due to the lack of health care plans, this often meant that life-threatening medical problems such as addiction and mental health were left unaddressed and untreated. This also meant that those without health insurance, getting medical treatment for addiction was not even an option, even though it was a major necessity. 

Thanks to the Affordable Care Act (ACA), a healthcare law passed by Congress in 2010, significant changes in healthcare were made, regarding federal programs and tax policies, and most importantly,  the financing of medical care, insurance coverage affordability, and the operations of Medicare and Medicaid programs. 

In other words, the ACA has made paying for drug and alcohol rehab costs more affordable, and most importantly, eligible to be covered under insurance. 

What Does Addiction Treatment Cover? 

Insurance plans may cover the following types of addiction treatment:

  • Detox (Medically-Assisted Detox) including anti-craving medications
  • Co-occurring mental health conditions
  • Intervention
  • Alcohol and drug testing
  • Addiction intake and evaluation process
  • Addiction treatment medication
  • Family therapy
  • Individual therapy 
  • Home health visits

What Types of Rehab Facilities Are Covered?

When you or a loved one decides to get help for addiction, that is probably the most important decision that you will make. The two main treatment programs that people are placed in our inpatient and outpatient. 

Inpatient Treatment 

Inpatient treatment requires individuals to stay at the rehab facility while attending counseling and therapy sessions and receiving around-the-clock medical monitoring. 

Outpatient Treatment 

If enrolled in an outpatient program, individuals will live at home while maintaining their independence. They will go to the treatment facility to receive extensive hours of therapy and treatment weekly, while still attending school and work. Addiction treatment facilities can provide several different types of care, including:

Types Of Insurance Plans For Addiction Treatment

Addiction is no longer considered a pre-existing condition, and therefore, if you are addicted to drugs and alcohol, the Affordable Care Act may help pay for it. There are three main types of insurance plans that commonly cover addiction treatment. Group, private, or public plans

Group Insurance Plans

If you are a member of a certain group, such as a place of employment, group insurance plans are often offered as part of a benefits package. 

Usually how it works is, businesses with fewer than 50 employees provide plans that cover the essential health benefits such as addiction treatment, and businesses with more than 50 employees may have more flexibility in the amount and types of coverage that they are allowed to provide. 

Due to the newly changed guidelines regarding treatment for addiction and mental health, major insurance carriers do provide coverage for both. Either partial or complete addiction coverage is offered by the employer under group insurance plans. 

Private Insurance Plans 

Private insurance for addiction treatment is the type of plans a person receives as an independent of an organization, or through an employer. Private medical insurance plans often require higher co-pays (out-of-pocket) premiums, but typically provide the highest-quality control over individual coverage and flexibility. 

The biggest benefit of private insurance plans is that people can choose the level of coverage they want, such as PPO and HMO, meaning more options for various types of treatments, and fewer limitations on in or out of network. 

HMO

HMO means that people with addiction and mental health issues can only choose to seek treatment at a drug and alcohol rehab center with providers that are ONLY within their specific network, or they will have to pay more, probably out-of-pocket. 

PPO

PPO insurance plans stand for Preferred Provider Organization. These are similar to HMO, except PPO plans offer a higher level of coverage if treatment is provided in-network. Through PPO treatment sought out-of-network may be still covered under your plan, but at a reduced rate.

Verifying Coverage and Finding the Best Treatment

Finding Drug And Alcohol Rehab Centers That Accept My Plan

While there are other ways to pay for addiction treatment, insurance is the most viable way to cover costs and alleviate financial burdens so individuals and their loved ones can instead focus on the most important factor: finding the best treatment possible. 

Therefore, our multidisciplinary team here at Granite Mountain helps people suffering from substance use disorders (SUD) and mental health disorders recover and maintain sobriety. 

We accept the following addiction treatment insurance plans:

As many rehab treatment facilities ate willing to offer payment plans and other installments to help ease the financial burden and stress of paying for medical expenses, especially addiction treatment, Granite Mountain prides ourselves on doing just that, as it is our philosophy of care. 

If you are ready to take that leap of faith and enter addiction treatment, we would love to help you learn which type of treatment your insurance covers. Our knowledgeable insurance verification specialists are standing by to help you find the treatment that is right for your circumstances. 

If Insurance Doesn’t Cover, There Are Other Options 

For many, paying for a drug and alcohol rehab program is the first concern when entering addiction treatment. Unfortunately, sometimes insurance won’t cover everyone’s specific treatment circumstances, and needs are different.

If insurance programs are not working as a form of payment, we can even help you find alternative payment options if your policy doesn’t cover what you need. To learn more about how to verify your insurance, click here

Reasons Behind Avoidance of Treatment 

For some individuals, they may not see they have a problem, and others are in complete denial. Truth is, several barriers can discourage someone from getting help, and many people avoid treatment due to a combination of factors, including: 

  • Stigma: The stigma surrounding addiction deters people from getting the crucial help that they need to recover. 
  • Lack of awareness and knowledge 
  • Denial
  • No support system
  • Environmental factors
  • Psychological characteristics
  • Lack of proper resources

These reasons above do not have to deter you from getting the help that you or a loved one needs for addiction treatment. 

Ready to Get Help? Granite Mountain Can Help!

Our health insurance benefits are designed to make health care more affordable and accessible for our patients, with no stigma attached. People with addiction should be able to receive access to healthcare that they need to the fullest order.

At Granite Mountain, our staff and addiction treatment facility believe in leaving addiction behind for good! To learn more about how your insurance plan can help you recover from addiction and regain control over your life, contact us today!

References

https://www.rehabs.com/insurance-coverage/substance-abuse-treatment/

https://www.drugrehab.com/treatment/barriers-in-seeking-treatment/

https://www.oxfordtreatment.com/addiction-treatment/paying-for-treatment/insurance/

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

 

Article Reviewed by Gregory Struve

Gregory StruveGreg received a Master’s in Counseling from the Adler Graduate School in 2006. He trained at one of the top trauma and anxiety treatment centers in the world until 2008, when he became a faculty member at Grand Canyon University. From 2011 to 2016 he directed a program that lead the field in terms of innovative treatment of anxiety and trauma. During that time he even made several appearances on A&E’s intervention.